Table 1

Documentation best practices, barriers and additional questions

Purpose of indication	Barriers	Best practices	Future questions
Improve antibiotic prescribing during order entry (eg, nudging, decision support or mindful moment).	Alert fatigue. Uncertainty of diagnosis. Need for efficiency. Gaming. Incongruent with decision-making process.	Early end-user engagement during design and testing. Incorporate into existing workflows. Frame in terms of improved patient care. Make doing the ‘right’ thing easy.	How to streamline documentation (ie, reduce the need for multiple places/layers of documentation)? Can mindful moments be triggered in other ways (eg, during note writing, checklists, timeouts)?
Allow prospective audit and feedback.	Resistance to feedback. Highly clinician dependent. Resource intense.	Use existing documentation rather than requiring additional documentation. Frame in terms of improved patient care.	How can hospitals with fewer resources successfully conduct prospective audit and feedback?
Communication.	Redundancy of documentation. Multiple modalities for documentation (paper, EHR). Multiple systems preventing closed loop communication. Need to protect patient privacy.	Mandatory indication on prescriptions. Patient instructions with clear antibiotic indication and directions. Frame as a safety issue.	How to harness technology to communicate across settings without imposing threats to patient privacy?